Department of Obstetrics and Gynecology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China.
Department of Obstetrics and Gynecology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China.
J Sex Med. 2020 Oct;17(10):1942-1955. doi: 10.1016/j.jsxm.2020.06.008. Epub 2020 Jul 18.
A growing body of research investigates the sexual functioning status in women with contraceptives use; however, the evidence is still inconclusive.
To examine whether contraceptives use is associated with a higher risk of female sexual dysfunction (FSD).
The electronic databases MEDLINE, Embase, Cochrane Library databases, and PsychINFO were systematically screened for eligible studies before December 2019. We only included those studies assessing women's sexual functioning by the Female Sexual Function Index (FSFI). This study was registered on the PROSPERO (ID: CRD42020167723, http://www.crd.york.ac.uk/PROSPERO).
The strength of the association between contraceptives use and risk of FSD was presented by calculating the standard mean dierences (SMDs) and the relative risk (RR) with a 95% confidence interval (CI). The pooled results were calculated using a random-effects model.
A total of 12 studies (7 cross-sectional studies, 3 cohorts, and 1 case-control study) involving 9,427 participants were included. The mean age in the contraceptive users ranged from 22.5 ± 2.4 years to 38.2 ± 4.6 years, while the mean age in the nonusers was 22.5 ± 2.4 years to 36.0 ± 1.0 years. Pooled results showed that no significant difference in the total FSFI scores was observed between contraceptives use and noncontraception (SMD = -1.03, 95% CI: -2.08 to 0.01, P = .053; heterogeneity: I = 98.2%, P < .001). In line with this finding, the pooled RR also yielded no association between contraception use and the risk of FSD (RR = 1.29, 95% CI: 0.72-2.28, P = .392; heterogeneity: I = 76.0%, P = .0015). However, the subscale sexual desire showed a significant reduction in women who received contraceptives than those did not use contraception (SMD = -1.17, 95% CI: -2.09 to -0.24, P = .014; heterogeneity: I = 97.7%, P < .001), while no significant differences were found in sexual arousal, lubrication, orgasm, satisfaction, and pain domain.
Though evidence from this meta-analysis did not support an association between contraceptives use and the risk of FSD, the sexual desire could be significantly impaired by contraceptives use.
STRENGTHS & LIMITATIONS: This is the first meta-analysis quantifying the relationship between contraceptives use and the risks of FSD. However, substantial heterogeneities were presented across the included studies.
No direct association between contraceptives use and the risk of FSD was found. Nevertheless, declining sexual desire was significantly associated with contraceptives use. Additional double-blind, randomized, placebo-controlled trials are still warranted. Huang M, Li G, Liu J, et al. Is There an Association Between Contraception and Sexual Dysfunction in Women? A Systematic Review and Meta-analysis Based on Female Sexual Function Index. J Sex Med 2020;17:1942-1955.
越来越多的研究调查了使用避孕药的女性的性功能状况，但证据仍不明确。
研究使用避孕药是否与女性性功能障碍（FSD）的风险增加有关。
系统检索了 MEDLINE、Embase、Cochrane 图书馆数据库和 PsychINFO 数据库，以获取截至 2019 年 12 月之前的合格研究。我们仅纳入了那些使用女性性功能指数（FSFI）评估女性性功能的研究。本研究已在 PROSPERO 上注册（ID：CRD42020167723，http://www.crd.york.ac.uk/PROSPERO）。
共纳入了 12 项研究（7 项横断面研究、3 项队列研究和 1 项病例对照研究），共纳入 9427 名参与者。避孕药使用者的平均年龄为 22.5±2.4 岁至 38.2±4.6 岁，而非使用者的平均年龄为 22.5±2.4 岁至 36.0±1.0 岁。汇总结果显示，避孕药使用者与非使用者的总 FSFI 评分无显著差异（SMD=-1.03，95%CI：-2.08 至 0.01，P=0.053；异质性：I=98.2%，P<0.001）。同样，避孕药使用与 FSD 风险之间的汇总 RR 也无关联（RR=1.29，95%CI：0.72-2.28，P=0.392；异质性：I=76.0%，P=0.0015）。然而，性欲亚量表显示，服用避孕药的女性性欲明显下降，而未服用避孕药的女性则没有（SMD=-1.17，95%CI：-2.09 至-0.24，P=0.014；异质性：I=97.7%，P<0.001），而在性唤起、润滑、性高潮、满意度和疼痛方面则没有显著差异。
尽管这项荟萃分析的证据不支持避孕药使用与 FSD 风险之间的关联，但避孕药的使用可能会显著损害性欲。
这是第一项定量评估避孕药使用与 FSD 风险之间关系的荟萃分析。然而，纳入的研究存在显著的异质性。
未发现避孕药使用与 FSD 风险之间存在直接关联。然而，性欲下降与避孕药使用显著相关。仍需要进行更多的双盲、随机、安慰剂对照试验。
